Eur Urol Suppl 2006;5(2):268 981 TRANSVAGINAL BONE-ANCHORED SLING (BAS) FOR TREATMENT OF STRESS URINARY INCONTINENCE: INTERMEDIATE-TERM FOLLOW-UP Giberti C. 1 , Siracusano S. 2 , Lavagna M. 1 , Ciciliato S. 2 , Cortese P. 1 1 San Paolo Hospital, Urology, Savona, Italy, 2 University of Trieste, Urology, Trieste, Italy INTRODUCTION & OBJECTIVES: Transvaginal pubic bone anchoring represents a minimally invasive technique for cystourethropexy or urethral sling suspension. The overall cure rate of 81.3% combined with the reduced operative time, short hospitalization, and lower morbidity make them an attractive alternative for the treatment of female patients with genuine urinary stress incontinence. At present there are few data on intermediate-term follow-up in patients who underwent BAS. We report a retrospective analysis of results with reference to complications of this procedure in the intermediate term. MATERIAL & METHODS: Between 1997 and 2002, we treated with BAS 239 women (median age 63) with diagnosis of stress urinary incontinence (SUI) due to a defect of anatomical support in 224 patients (93.7%) and due to intrinsic sphinteric deficiency (ISD) in 15 patients (6.3%). The sling consisted of cadaveric fascia, fascia lata and rectus fascia in 3.8%, 2.9% and 10.8% of cases respectively and of porcine dermal collagen in 24.6% and of polypropylene in 8.8% of cases. Cystocele was present in 74.8% of cases, rectocele in 46.8% of cases and uterine prolapse in 8.8% of cases. Sling was placed under bladder neck in 26 patients (10.9%) and under middle urethra in 213 patients (89.1%). All patients were evaluated with self-assessment Korman questionnaire. RESULTS: Mean follow-up was 38.8±18.8 months. 3% of women did not reply to the questionnaire. Incontinence was cured in 60.6% of cases, it remained unchanged and worsened in 24.2% and in 12.1% respectively. The patients referred incontinence in 5.8%, urinary retention in 1.7% and urgency in 4.6%. Three patients (1.2%) experienced perineal pain. Cystocele and rectocele relapsing was observed in 5.8% and 1.7% respectively. Vaginal erosion was present in 4.6% of cases and sling dislocation in one case (0.4%). We remove sling in 9.2% of patients. No urethral erosion was observed. CONCLUSIONS: In female BAS seems to be a technique with a high rate of complications for treatment of female SUI if compared with other mininvasive techniques. 982 PROSPECTIVE, MULTICENTRE, RANDOMISED STUDY COMPARING RETROPUBIC AND TRANSOBTURATOR ROUTES IN FEMALE STRESS INCONTINENCE CURE. FUNCTIONAL OUTCOMES AT THREE MONTHS David-Montefiore E. 1 , Daraï E. 1 , Grisard-Anaf M. 2 , Bonnet K. 3 , Frobert J.L. 4 , Lienhard J. 5 1 Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Service de Gynécologie Obstétrique, Paris, France, 2 Clinique Sainte Anne Lumière, Service d’Urologie, Lyons, France, 3 Hôpital Antoine Beclere, Assistance Publique Hôpitaux de Paris, Service de Gynécologie Obstétrique, Paris, France, 4 Hôpital de Bourg en Bresse, Service de Gynécologie Obstétrique, Bourg en Bresse, France, 5 Clinique Trénel, Service d’Urologie, Sainte Colombe, France INTRODUCTION & OBJECTIVES: To compare functional results, at 3 and 6 months post-operatively, of the sub-urethral sling procedure for urinary stress incontinence by the retropubic and transobturator routes, using a non-elastic polypropylene suburethral sling. MATERIAL & METHODS: This prospective, multicentre study involved 88 women undergoing the suburethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in respectively 42 and 46 cases. The characteristics of the women in the RPR and TOR groups were as follows: mean age (± standard deviation) 56.8 ± 12 years and 53.4 ± 10 years, respectively; mean BMI: 25 ± 4 and 26 ± 4; mean parity: 2.1 ± 0.9 and 2 ± 1 children; post-menopausal status: 66.7% and 58.7%; prior surgery for SUI: 7.1% and 6.5%; and prior hysterectomy: 21.4% and 26.1%. None of these characteristics differed significantly between the groups. Likewise, pre-operative urinary functional status (SUI stage, and pollakiuria, nocturia and urgency rates) was similar in the two groups. Although mean hospital stay and overall morbidity rate were not significantly different between the RPR and TOR groups, rate of bladder injury was higher in the RPR group (9.5% vs. 0%, p=0.03). Post-operative pain was also more important in the RPR group (pain scores 2±2 vs. 0.8±1.4, p=0.0005). Mean operating time was longer in the RPR group. RESULTS: At three months post-operatively, in the RPR and TOR groups, 89.3% and 88.6% of women were dry, respectively. There was a de novo pollakiuria in 10.7% and 5.7% of women, and a de novo urinary urgency in 17.9% and 17.1% of women, respectively. Rate of satisfaction, in the RPR and TOR groups, was 90% and 92%, respectively. CONCLUSIONS: The suburethral sling procedure for the cure of stress urinary incontinence, by the TOR route and by the RPR route, has similar functional results at three and six months. 983 PERIURETHRAL PROLENE MESH SUPPORTED VAGINAL WALL SLING: NEW PERIURETHRAL FIBROSIS PROCEDURE FOR THE TREATMENT OF STRESS URINARY INCONTINENCE Kaya C., Pirincci N., Kanberoglu H., Ozturk M., Karaman M.I. Haydarpasa Numune Training and Research Hospital, Urology, Istanbul, Turkey INTRODUCTION & OBJECTIVES: Stress urinary incontinence (SUI) is a common problem in women. Although many surgical procedures have been proposed for treatment, they have remained controversial. We evaluated the safety and efficacy of an easy and cheaper method, periurethral prolene mesh supported vaginal wall sling, in the treatment of female SUI. MATERIAL & METHODS: 27 patients with a mean age of 50.2 who underwent our new procedure for SUI were prospectively analysed. All patients provided a detailed history, which included an incontinence impact questionnaire to assess the impact in quality of life before surgery, physical examination and urinalysis. They were assessed preoperatively by urodynamic study including vLPP. A pair of prepared 2 x 2 cm prolene mesh was introduced into bilateral longitudinal incisions of the anterior vaginal wall 2 cm distant from the urethral meatus after the dissection of vaginal mucosa until identification of the retropubic space at the level of bladder neck and mid urethra was performed by sparing urethral anatomy. Then the mesh was sutured with helical passed no 1 prolene bilaterally. Cystoscopy is performed to rule out bladder or urethral perforation. A small incision is made suprapubically and a Stamey needle is passed under finger control through the fascia and retropubic space. The previously placed prolene sutures tied on mesh are transferred to the suprapubic incision and cross-tied on rectus fascia over a 2 x 2 cmmesh. The mean duration of operation was 43 minutes and average hospitalization time was 3.2 days. Efficacy is defined as postoperative incontinence secondary to either stress, number of pads used postoperatively, and urinary incontinence assessment by the patient as ‘very satisfied, satisfied, no change and dissatisfied’. RESULTS: The mean follow-up of the patients was 13.4 months. The mean parity was 5.1 childbirths (0 to 11). 78% underwent concomitant organ prolapsed surgery. The mean duration of SUI was 4.2 years. 11 patients (40.7%) were with grade 2 SUI and 16 patients (59.3%) with ISD. 9 patients (33.3%) had urge incontinence. of 27 patients, 20 (74%) were cured of SUI and 5 (18.5%) were improved. Urinary retention was not seen in any of them. The post-operative urodynamic study did not show detrusor instability in any patients. Any complications such as proloned retention greater than 1 month, de novo urge incontinence, urethral erosion, urinary tract and wound infection were not found. CONCLUSIONS: This operation is an effective technique for the treatment of female SUI for patients both with urethral hypermobility and with ISD. The possible long durability of the procedure because of the periurethral fibrosis secondary to the tension of prolene mesh should be assessed in studies with longer-term follow-up period. 984 TRANSVAGINAL ENDOSONOGRAPHY IN THE EVALUATION OF TENSION-FREE VAGINAL TAPE (TVT) IMPLANTATION Loch A. 1 , Stöckle M. 2 , Loch T. 3 1 Diakonissenkrankenhaus Flensburg, Klinik für Urologie, Flensburg, Germany, 2 Universität Des Saarlandes, Urologie, Homburg, Germany, 3 Diakonissenkrankenhaus Flensburg, Urologie, Flensburg, Germany INTRODUCTION & OBJECTIVES: Tension free implantation and correct positioning is crucial for the successful implantation of TVT (tension free vaginal tape). Possible causes for complications are displacement or over correction of the tape. We tried to verify correct implantation by endovaginal ultrasound (EU) and tried to define parameters that objectify parameters of displacement. MATERIAL & METHODS: We evaluated 43 women 4 weeks up to 2.5 years after implantation of TVT. All patients were evaluated by 7 Mhz transvaginal EU. In 35 women the TVT implantation was performed in our hospital. 8 women were referred to our clinic because of complications after TVT implantation. In 21% a preoperative mixed incontinence and in 79% a stress incontinence grade I-III were the indication for the operation. RESULTS: In all women the polypropylene tape could be identified as a hyperechoic structure. The convex appearing TVT dorsal of the urethra was clearly demonstrable. We measured the distance between the mucosa of the urethra and the tape as well as the distance of the tape to bladder neck in the longitudinal view. For continent women the median distance of the tape to the mucosa of the urethra was measured 5 mm. The median distance of the tape to the bladder neck was 13 mm in the longitudinal view. In 6 patients with urgency and/or residual urine the tape was less than 5 mm to the urethral mucosa. In one woman the tape was clearly displaced in the proximal third of the urethra. We successfully incised the tapes in all of these patients. CONCLUSIONS: Transvaginal EU seems to be a feasible method to evaluate correct placement of prolene mesh after TVT placement. This minimal invasive diagnostic method allows judgement of correct placement and evaluation of the tape in relation to the anatomic structures. In our opinion transvaginal EU can compliment the clinical and urodynamic evaluation.